Medication Reconciliation at Nakhon Ratchasima Rajanagarindra Psychiatric Hospital

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Kanita Puntakul
Acharawan Topark-Ngarm


Introduction: Medication errors (MEs) are one of the leading causes of adverse events and usually  occur at transitions of care. Communication problems between patients and healthcare professionals are among  the causes of MEs.In general, psychiatric patients may have difficulties in communication, which may lead to  MEs. Medication reconciliation is a critical process to ensure patient safety. The objectives of this study were to  determine 1) frequency and types of MEs 2) factors associated with MEs 3) physicians’ responses to medication  reconciliation and 4) amount of time required for medication reconciliation. Materials and Methods: This study was a prospective descriptive study performed at the Nakhon Ratchasima Rajanagarindra Psychiatric Hospital. Medication reconciliation was carried out by a pharmacist at admission and discharge in patients hospitalized during 15 February to 15 April 2010. The pharmacist identified medication discrepancies and evaluated whether they were MEs. Physicians’ responses and time spent during medication reconciliation, which consists of four steps 1) verification of data 2) data clarification 3) identification of medication discrepancy and intervention 4) data transmission, were recorded. Results: In a total of 206 patients, we found 65 MEs in 27 patients (13.1%). There were 36 and 29 errors found at admission and discharge, respectively. The most common errors were omission errors (49 errors, 75.3%), following by incorrect dose and incorrect time (5 errors of each, 7.7%). Factors that independently increased the risk of medication errors were 1) having co-morbidity 2) the number of medications prior to admission and discharge and the number of home medications. After pharmacist intervention, 62 out of 65 MEs were positively responded by physicians (95.4%) and subsequently solved. Pharmacists spent a mean time of 13.7±2.7 minutes per patient to gather patients’ background histories. The average times to review and create a medication list at admissionand discharge were 5.0±1.2 and 5.0±1.3 minutes per patient, respectively. The average times to assess medication errors at admission and discharge were 5.5±2.4 and 4.4±1.4 minutes per patient, respectively. The average times for intervention and checking for physician’s responses at admission and discharge were 7.3±1.7 and 7.0±2.2 minutes per patient, respectively. Conclusions: Although medication reconciliation required more pharmacist’s time, it likely prevented MEs at transitions of care. We suggest that closer attention should pay to high-risk patients who have co-morbidity and been on several medications to ensure patient safety.


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Pharmaceutical Practice


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